What might patient safety have to do with the joy and spirit of caregiving?
With the advent of electronic health record implementation, never-ending administrative duties, and unrelenting changes, it's no surprise that practitioners often talk about losing the joy of caregiving. In fact, many patient safety and quality conferences have begun to focus on this theme. Practitioners often lament that medicine is becoming less of a "craft" and turning into a standardized methodology-sucking the joy out of caregiving and making the art of their practice obsolete. Of course, the other side argues that the need to minimize variation and practice pure, objective, evidence-based medicine should be the norm and not the exception.
This divide is especially acute when the conversation centers on clinical practice guidelines, order sets, protocols, and what some providers refer to as "cookbook medicine." It can lead to a dynamic and sometimes dangerous discussion in any room with a mixed administrative and clinical audience.
At the recent National Quality Colloquium, one session focused on how physician engagement affects the organizational and patient safety culture. It became clear that given the immense changes under way in the U.S. healthcare system, and the need to reduce variation, eliminate waste, and improve quality, practitioners' feelings of autonomy loss are bound to become more pronounced.
The discussion at NQC reminded me of a recent meeting in my own company. We had invited a group of nursing executives to engage in dialogue with us for a half day, discussing their challenges, needs, and hopes for their frontline staff and organizations. Beyond some of the typical things we expected to hear, like "we have scorecards coming out our ears" and "our systems are so complex, it makes any process improvement work daunting," we heard something else loud and clear: "If you are going to bring any new technology into our environment, it should help put the spirit back in nursing."
We were prepared to address many of their comments. Putting the spirit back into the profession, however, was a message that made us take pause as a company. It's a tall order, but one that has become an important mission.
I think about the outcry from providers, physicians, and nursing to bring joy and spirit into a process they feel has been threatened by the automation, digitization, and guideline-driven care delivery being imposed on them. I am starting to look at care systems in a different way and ask new questions-mostly because we can't, as a system, reject the notion of minimizing variation.
So how do we practice evidence-based care while preserving the craft and recapturing the spirit through which our providers set out to practice medicine? Where does this joy of caregiving really stem from? Is the spirit of nursing found in the way a checklist is performed or in how a provider makes her wishes for order execution apparent? Do the guidelines limit this joy?
I would argue that the joy actually comes from witnessing the results of successful care delivery, from seeing the experience of a patient and family walk through a healing journey. Some argue that this joy and spirit is fading because of the stress and chaotic nature of the systems and environment in which our caregivers deliver care. If a guideline is truly evidence-based, the problem most likely isn't about using it for decision-making support; rather, the problem likely stems from an inability to find the guideline when it's needed, communicate it to nursing, find time to document the use of it, and so on.
If we take a step back to understand the origin of caregivers' protests, we might find that we can accomplish both the safeguarding of deep-rooted expertise and the joy of medicine and care delivery, while ensuring that quality isn't sacrificed for the sake of autonomy.
I am confident that spirit can be restored, patient safety can be improved, and evidence-based practice guidelines can be implemented successfully all at once. We need to ensure that the results are proven and communicated, and that the "cookie-cutter" systems we require actually support the providers seamlessly, helping them to make autonomous-yet better-informed-decisions for care.